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A Comparison of Fentanyl With Pethidine for Pain Relief During Childbirth: A Randomized-Controlled Trial

Fleet, J.; Belan, I.; Jones, M.J.; Ullah, S.; Cyna, A.M.

doi: 10.1097/01.aoa.0000482640.41679.64
Anesthesia Analgesia: Alternative Methods of Analgesia
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(BJOG. 2015 Jun;122(7):983–992)

Pethidine (meperidine) is the most commonly administered opioid for labor pain in women unable or unwilling to undergo epidural analgesia. It has a slow onset and the potential for adverse effects, due in part to the active metabolite norpethidine (normeperidine), which has been associated with neuronal depression in the neonate for up to 60 hours after birth. The faster-acting opioid fentanyl has shown promise as an alternative to pethidine, with the advantages of rapid onset, short duration, and no active metabolite. In studies comparing intravenous (IV) fentanyl with IV pethidine in the obstetric setting, IV fentanyl resulted in fewer adverse effects in both mother and baby. Less invasive intranasal (IN) and subcutaneous (SC) fentanyl have been shown to be efficacious in nonobstetric settings, but few studies have examined the administration of fentanyl by these routes in laboring parturients. This randomized-controlled trial compared the efficacy of fentanyl administered intranasally or subcutaneously with intramuscular (IM) pethidine for labor analgesia, as measured by pain scores 30 minutes after treatment. Important secondary maternal outcomes included the rating of perceived feelings of control during labor using the Labor Agentry Scale (LAS) questionnaire, and satisfaction with the treatment intervention, determined by the participant’s willingness to use the treatment again.

School of Nursing & Midwifery, Flinders University, Adelaide, SA, Australia

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